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CITY OF OSHKOSH N 39688
PERMIT APPLICATION AND RECORD
TYPE: BLDG HTG ELEC X PLBG SIGN ZONING FLOOD PLAIN HEIGHT
ADDRESS
PLAN NO.
OWNER c
DESIGNER
USE /NATURE OF WORK
BUILDING CONTRACTOR
Size Sq. Ft. Rooms Stories Height
Foundation Class of Const. Occupancy Permit
HEATING CONTRACTOR
Heat A/C Vent Fuel /System Heat Loss BTU'S
ELECTRIC CONTRACTOR l
Electric Serv. New�Change Temp Type A volts Amps Oct
Fixtures Switches Receptacles Circuits
PLUMBING CONTRACTOR
BT WH Disp WSoft CBasin
Lav Sh DW DF San. Sewer
WC FDr SP Ur Storm Sewer
Sink LTub Eject SS Water
Other
FEES: Valuation o10 O D Permit Fee Paid o Park Dedication
ISSUED BY 2-1 -PI--". Date S/ 774 Final /O.P.
In the performance of this work I agree to perform all work pursuant to rules governing the described construction.
SIGNATURE
AGENT /OWNER DATE
ADDRESS
TELEPHONE